上直筋・外直筋縫着術が奏効した固定内斜視の1例

Fixation suture of superior and lateral rectus muscles was effective in a case of strabismus fixus

　74歳女性が60歳の頃から進行してきた内斜視で受診した。幼少時から強度近視があり，20年以上前に両眼に白内障手術を受けている。矯正視力は右0.4，左指数弁で，眼軸長は左右とも約30mmであった。左眼が45°以上内下転し，全方向に眼球運動制限があった。磁気共鳴画像検査（MRI）でぶどう腫化した眼球後部が上直筋と外直筋を押し分けて筋円錐外へ脱臼していた。治療として上直筋と外直筋の筋腹を縫着した。眼位はほぼ正位になり，眼球運動は全方向で改善した。MRIで眼球が筋円錐内に整復され，上直筋と外直筋の偏位も軽快していた。強度近視に伴う固定内斜視に直筋の縫着が有効であった症例である。

　A 74-year-old woman presented with progressive esotropia of 14 years'duration. She had had high myopia since childhood. She had received cataract surgery more than 20 years before. Her corrected visual acuity was 0.4 right and counting fingers left. The axial length was about 30mm in either eye. The left eye deviated inferonasally by 45 degrees. Its movement was restricted in all directions. Magnetic resonance imaging（MRI）showed the staphylomatous posterior portion of the eyeball to have luxated through the superior and lateral rectus muscles. We treated the left eye by suturing the superior and lateral rectus muscles. After surgery,the eyes became parallel. Eye movements became normalized. MRI showed the eyeball to be positioned within the muscle cone. This case illustrates the efficacy of suturing the rectus muscles to the eyeball for strabismus fixus associated with high myopia.